Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report. Issue 143 (July 2016) - Yamaguchi, Yoshitaka
Abstract: A 79-year-old lean man with a height of 157 cm and weight of 42 kg (body mass index, 17.2 kg/m 2 ) receiving rivaroxaban developed an intracranial subdural hematoma and was treated conservatively. Because he had a reduced creatinine clearance of 44 mL/min, his dosage of rivaroxaban was reduced from 15 to 10 mg daily according to official Japanese prescribing information. However, he developed bilateral intracranial subdural hematomas 2 weeks later. Plasma rivaroxaban concentration on anti-factor Xa chromogenic assay was elevated at 301 ng/mL, suggesting excessive accumulation. He underwent burr hole drainage and resumed anticoagulation with warfarin. Subsequently, he developed a lumbosacral hematoma. He was treated conservatively and discharged without neurological sequelae. The main cause of the increased concentration of rivaroxaban was believed to be his older age and low body weight. The etiology of the spinal hematoma was suspected to be the migration of intracranial hematoma to the spinal subdural space.